FLISHA REESE

• Provide compassionate, person-centered behavioral health support while maintaining client dignity, confidentiality, and safety.
• Assisted clients with daily living needs and community integration, achieving individualized service-plan goals through trauma-informed practices.
• Observed client behavior, documented services and progress, and communicated relevant updates to enhance care team collaboration.
• Observed client behavior, document services and progress accurately, and communicate relevant updates to the care team.
• Coordinated with clients, families, and interdisciplinary care partners, ensuring compliance with agency procedures and HIPAA requirements.

• Associate Testing Analyst Sr
• Developed and implemented testing protocols for system enhancements, products, and processes, ensuring comprehensive customer-service coverage.
• Coordinated vendor-contract quality audits; validated test outcomes, documented discrepancies, and ensured timely issue resolution.
• Facilitated communication between system users and IT teams, contributing to business and technical strategies for provider data management.
• Reviewed contract installations and managed system and application audits to support trend analysis and enhance quality reporting.
• Maintained accurate provider information and complex data transactions to strengthen provider relations and ensure regulatory compliance.

• Processed medical, dental, and behavioral health claims, ensuring accurate payment and adherence to company guidelines and regulations.
• Resolved claim-status inquiries and denials for health-plan providers, enhancing support experience through effective telephone communication.
• Investigated contract, appeal, and billing issues, improving production flow and provider relations.
• Investigated contract, appeal, and billing issues to streamline production flow and strengthen provider relations.

• Audited telephone interactions and provided quality reports that identified error causes and outlined improvement opportunities.
• Processed Medicare Part A and Part B claims while addressing provider and member inquiries with precise information.
• Adjudicated complex claims using policy guidelines, contract terms, and documented evidence.
• Reviewed claim files for completeness, accuracy, and compliance with regulatory requirements.
• Coordinated with internal teams to resolve escalated claim discrepancies and payment issues.

Medical Insurance Claims Certification | ICD-9 and ICD-10 Coding Certification | CPT, Medical Terminology, and Insurance Laws Certification | Provider Contracts Certification | Provider Credentialing Certification